The subject matter described herein relates to an electrosurgical instrument for ablating tissue and, more particularly, to a bi-polar radio frequency, electrosurgical instrument for ablating tissue. More specifically, the subject matter has particular utility in forming lines of ablation in cardiac tissue. However, it is not limited to such application.
Atrial fibrillation (“AF”), is a cardiac rhythm disorder and is one of the most common types of heart arrhythmia. AF is understood to result from errant electrical impulses in the heart tissue, and one surgical treatment for AF involves creating lines of scar tissue in the heart that serve to block the pathways for the errant electrical impulses. Lines of scar tissue may be created by various ablation techniques, including surgically cutting the heart tissue, freezing the tissue with cryogenic probe, and heating the tissue with radio frequency (“RF”) energy.
Exemplary RF instruments for cardiac ablation and the methods of use of such instruments are disclosed in, e.g., U.S. Pat. Nos. 6,546,935, 6,899,710, 6,905,498 and 6,974,454, all of which are incorporated by reference herein. These patents are generally directed to bi-polar RF ablation instruments with opposed jaws, each jaw having an ablation element or RF electrode thereon, with the jaws being relatively moveable so as to clamp tissue therebetween. Such clamps can provide for generally consistent compression of the tissue held between the clamp jaws, resulting in good electrical contact and the targeted delivery of RF energy. A bi-polar RF ablation clamp such as those disclosed in the above-referenced patents is available from AtriCure, Inc. as the Isolator® Ablation Clamp.
In addition to the bi-polar clamps for ablation with the ablation electrodes on the opposed jaw members, such as those described above, it is also known to provide a bi-polar RF ablation instrument that has the ablation elements spaced apart and carried on a single working surface attached to the end of a semi-rigid shaft. Such an instrument may be used in the same procedure as the bi-polar clamps discussed above for making connecting ablation lines or lesions. See, e.g., U.S. Published Patent Applications Nos. 2006/0161149 and 2006/0161151, both published on Jul. 20, 2006, and 2008/0009853, published Jan. 10, 2008, which are incorporated herein by reference. Such instruments are commonly referred to as “pens”, and an exemplary bi-polar RF pen is also available from AtriCure, Inc. as the Isolator® Multifunctional Pen. This particular pen also includes pacing and sensing electrodes that permit the surgeon to confirm, during surgery, the creation of a transmural ablation with a single instrument.
In general, bi-polar electrode devices apply RF energy directly to and through the surface of the tissue engaged by the electrode members. The electrodes, with the target tissue engaged thereby, form a conductive resistive circuit. When the electrodes are energized, the moisture in the tissue conducts the RF energy between the electrodes and the tissue begins to desiccate. As the tissue desiccates, it becomes more resistive. Tissue desiccation spreads laterally and inwardly from the surface of the tissue near the electrode-tissue contact area, where the current flux or density is greatest. Surface desiccation increases the resistance in the tissue and can make it more difficult to achieve good depth of penetration in underlying tissue without creating a larger than desired area of ablated tissue or excessive surface heating adjacent to the electrodes. Accordingly, techniques have been developed to overcome these undesirable surface tissue heating effects, including cooling or cryogenics and the selected positioning of electrodes. See, e.g., U.S. Pat. No. 6,413,253 to Koop et al., U.S. Pat. No. 6,629,535 to Ingle at al. and U.S. Pat. No. 7,022,121 to Stern et al. and U.S. Pat. No. 6,918,906 to Long, also incorporated by reference.
Nevertheless, a significant need still exists for an improved electrosurgical device for ablating tissue.